New Screening Tool for Work-Related Depression

What’s happening – Psychologists have developed a new tool to identify, monitor, and treat depression stemming to a person’s job. Designed for clinicians and epidemiologists, their Occupational Depression Inventory (ODI) aims to measure work-related depressive symptoms. Issues such as job-related stress and sick leave for mental health can cost companies money and these remain important topics of research. Having a way to identify and measure depression caused by job-related factors is an important step. The developers – based at CUNY’s City College and Switzerland’s Institute of Work and Organizational Psychology –describe the ODI as showing “strong reliability and high factorial validity” and hope that research done using the tool may help to shape occupational health policies and regulations.

The details – Check out the full publication on the ODI in the Journal of Psychosomatic Research

The perspectives

  • WHO’s fact sheet on Mental Health in the Workplace estimates that more than $1 trillion in productivity is lost globally each year because of anxiety and depression among employees. WHO offers guidelines on creating a healthy workplace and lists work-related risk factors for mental health.
  • Occupational stress and its relationship to anxiety, depression, and PTSD are explored in this article, with several high-stress jobs are identified

Why it’s complicated – Job-related burnout syndrome and more recently, compassion fatigue, have been studied since the 1970s, but their definition and diagnostic criteria are unclear. Current research contends that burnout should be considered a depressive condition because of the overlap in symptoms.

    • A study by Dr. Renzo Bianchi (lead author of the ODI study and subject of this week’s Psy-Q trivia) argues that the distinction between burnout and depression can be particularly problematic if people don’t take burnout as seriously as they would depression and thus not seek treatment.
    • Here’s a look at remote work burnout during the current pandemic.
    • The American Psychiatric Association offers resources for physicians about well-being and burnout.
    • Speaking of depression evaluation, another recent study found that most parents involved in a nationwide survey about school-based depression screening were in favor of screens for middle school students, preferring to start evaluations in 6th grade rather than waiting until high school. Current guidelines on adolescent depression in primary care from the American Academy of Pediatrics can be found here in Part I and Part II – they recommend self-report screening beginning at age 12.

The conversation

  • @CityCollegeNY (City College of NY) tweeted an interview with Professor Irvin Sam Schonfeld, co-developer of the ODI and its validation study.
  • @ABC (ABC News) linked to a recent story about physicians facing burnout, consequences for discussing their own mental health issues, and high suicide rates.
  • @HarvardBiz (Harvard Business Review) asks when you should consider leaving your job because of burnout.

In practicePsycom Pro spoke to therapists struggling to find work-life balance during the pandemic and two psychiatry residents share what they are facing in terms of burnout. Plus, Boston Children’s Arial Botta shares stress-reduction techniques for HCPs.

Psy-Q

What is the difference between depression and burnout?

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Schizophrenia Research: New Findings in Etiology and Treatment Targets

What’s happening – Schizophrenia affects about 20 million people worldwide, according to the WHO, and the psychiatric disorder is often associated with considerable disability that disrupts people’s efforts to be successful in school and at work. Researchers are continually uncovering new understandings of the etiology of schizophrenia, leading to additional drug targets to improve treatment. In fact, the American Psychiatric Association released new practice guidelines for pharmacologic and psychosocial interventions in patients with schizophrenia in September 2020. Current efforts seek to reduce the cognitive impairments that often accompany the disorder – a few highlights below.

New research on the etiology of schizophrenia

  • Studies focused on the underlying biology of schizophrenia are at the center of this month’s American Journal of Psychiatry. In the Editor’s Note, Ned Kalin, MD, emphasizes the importance of understanding the neural circuits of normal cognitive, emotional, and behavioral functioning and, from there, investigating the differences that “play an etiological or pathophysiological role in mediating psychiatric illnesses.” Mitochondrial dysfunction was the subject of one such study looking at the links between schizophrenia and bipolar disorder.
  • A paper in Nature Communications demonstrated that defective cilia in the brain may be linked to some forms of severe schizophrenia. Senior Author Nicholas Katsanis, PhD, noted, “I cannot definitively say if it is the worsening cilia length that is causing this schizophrenic behavior, or if that is one part of the phenotype of these mutations. But this could explain why some patients are resistant to treatment.”
  • Others are wondering whether schizophrenia may be preventable through exercise. Findings published in Biochemical and Biophysical Research Communications showed that regular low-intensity exercise during adolescence in schizophrenia model mice significantly reduced abnormal behaviors.

New research on schizophrenia medications –

  • A Phase 1b drug candidate, CVN058 (Cerevance), received encouraging results for reducing cognitive impairment in individuals with schizophrenia. Specifically, a single dose of CVN058 showed a significant improvement of mismatch negativity, which is an auditory evoked potential generated in the cerebral cortex that is typically impaired in schizophrenics.
  • A study in Psychological Medicine reported that an intervention of the long-acting injectable antipsychotic risperidone (Invidior) and cognitive training significantly improved cognitive function in patients with early schizophrenia. (Janssen also has a long-acting psychotic in development – see below)
  • A review of RCTs using repeated transcranial magnetic stimulation (rTMS) to improve cognitive function in subjects with schizophrenia and bipolar disorder found some potential for the treatment, although more research is needed. Researchers found that rTMS had poor effects on improving cognitive function in patients with schizophrenia patients but mixed results for those with schizoaffective disorder.
  • A study in JAMA Network Open showed that using genetic testing to guide prescribing antipsychotics for schizophrenia patients was ineffective. The team concluded that routine use of CYP2D6 and CYP2C10 genotyping was not supported as it had no effect on antipsychotic drug persistence, adverse drug reactions, or positive psychotic symptoms when compared with monitoring and treatment as usual.

The conversation

  • @APAPubJournals (Journals of The American Psychiatric Association) tweeted a link to an article about treatment guidelines for treatment-resistant schizophrenia.
  • @sgopal2 (Srihari Gopal, head of development psychiatry at Janssen R&D of Johnson & Johnson) linked to Janssen’s announcement of its submission of a supplemental NDA to the FDA for paliperidone palmitate 6-month (PP6M), a long-acting injectable schizophrenia medication designed for twice-yearly doses.
  • @NeuroscienceNew (Neuroscience News) tweeted “Schizophrenia may, in part, be caused by immune system dysfunction, a new study reports.”

In practice – How one psychiatric nurse is taking advantage of teletherapy to manage patients with schizophrenia. Why people with schizophrenia experience disordered sleep and which treatment approaches may help.

Patient Disengagement from Early Intervention Services for Psychosis

What’s happening – Patient disengagement is not new but a recent review of the literature on disengagement rates in early intervention services (EIS) for psychosis appears to have identified some predictors. Potential predicting factors were categorized as:

  • predisposing – including sociodemographic characteristics
  • enabling – defined as personal, familial, and neighborhood features that must exist for individuals to use healthcare services, or
  • need – that is, the perceived need for health services by the patient and by clinicians.

Enabling factors, such as lack of family support and living alone, as well as need factors, such as medication non-adherence and substance misuse, were found to be predictive of disengagement from EIS. The authors concluded that more work is needed in the field to better define and measure disengagement and to develop strategies for re-engagement.

The details – Read the full review by Mascayano et al in Psychiatric Services

The perspectives

  • This review from 2014 drew similar conclusions, such as the need for clear definitions and measurements of disengagement in early treatment of psychosis. Factors such as a lack of family support or persistent drug use were associated with a higher risk of disengagement, which aligns with the recent study.
  • Similarly, predictors of disengagement for first-episode psychosis (FEP) patients included living without family and substance use in a 2010 study from Schizophrenia Research.
  • A look at the role of family engagement with early intervention services for psychosis compared groups in India and Canada.

Why it’s complicated – Keeping patients engaged in treatment can be a challenge for all areas of psychiatry and mental health, particularly for patients experiencing FEP. It is estimated that disengagement rates for specialized early intervention programs for patients with FEP ranged from 20% to 40%, according to a study focused on finding ways to better understand and improve engagement. The authors stressed the importance of understanding engagement as something that can change over time.

  • A study suggested that extending specialized early intervention care to 5 years may be more effective in preventing disengagement than the standard of 2 to 3 years of early intervention care for FEP.
  • High rates of disengagement in young adults with FEP were observed in a recent study along with the finding that a majority of those patients re-engaged with treatment. The authors concluded that the concept of disengagement might be more complex than previously thought and called for more research into why patients re-engage with services.

The conversation

  • Psychologist @chelsea_arnold_ linked to her work about predicting engagement with an online intervention for psychosis
  • Lead author @AnaCatalanPSQ tweeted a link to her team’s study looking at EIS, antipsychotic medications, and disengagement from services in patients with first-experience psychosis

In practice – Sherry Amatentein, LCSW, shares her experience with client disengagement and how she has worked through premature termination challenges.

 

 

Last Updated: Jul 20, 2021